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Prognosis of Spontaneous Pneumothorax/Pneumomediastinum in Coronavirus Disease 2019: The CoBiF Score

 Wongi Woo  ;  Vincent Kipkorir  ;  Adina Maria Marza  ;  Shadi Hamouri  ;  Omar Albawaih  ;  Arkadeep Dhali  ;  Wooshik Kim  ;  Zarir F Udwadia  ;  Abdulqadir J Nashwan  ;  Nissar Shaikh  ;  Alessandro Belletti  ;  Giovanni Landoni  ;  Diego Palumbo  ;  Sarya Swed  ;  Bisher Sawaf  ;  Danilo Buonsenso  ;  Inês Pimenta  ;  Filipe André Gonzalez  ;  Giuseppe Fiorentino  ;  Muhammad Redzwan S Rashid Ali  ;  Alvaro Quincho-Lopez  ;  Mohammad Javanbakht  ;  Ayat Alhakeem  ;  Muhammad Mohsin Khan  ;  Sangam Shah  ;  Moezedin Javad Rafiee  ;  Sri Rama Ananta Nagabhushanam Padala  ;  Sebastian Diebel  ;  Seung Hwan Song  ;  Du-Young Kang  ;  Duk Hwan Moon  ;  Hye Sun Lee  ;  Juyeon Yang  ;  Luke Flower  ;  Dong Keon Yon  ;  Seung Won Lee  ;  Jae Il Shin  ;  Sungsoo Lee 
 JOURNAL OF CLINICAL MEDICINE, Vol.11(23) : 7132, 2022-11 
Journal Title
Issue Date
coronavirus disease ; coronavirus disease 2019 ; pneumomediastinum ; pneumothorax ; prediction model
Objectives: Pneumothorax and pneumomediastinum are associated with high mortality in invasively ventilated coronavirus disease 2019 (COVID-19) patients; however, the mortality rates among non-intubated patients remain unknown. We aimed to analyze the clinical features of COVID-19-associated pneumothorax/pneumomediastinum in non-intubated patients and identify risk factors for mortality. Methods: We searched PubMed Scopus and Embase from January 2020 to December 2021. We performed a pooled analysis of 151 patients with no invasive mechanical ventilation history from 17 case series and 87 case reports. Subsequently, we developed a novel scoring system to predict in-hospital mortality; the system was further validated in multinational cohorts from ten countries (n = 133). Results: Clinical scenarios included pneumothorax/pneumomediastinum at presentation (n = 68), pneumothorax/pneumomediastinum onset during hospitalization (n = 65), and pneumothorax/pneumomediastinum development after recent COVID-19 treatment (n = 18). Significant differences were not observed in clinical outcomes between patients with pneumomediastinum and pneumothorax (±pneumomediastinum). The overall mortality rate of pneumothorax/pneumomediastinum was 23.2%. Risk factor analysis revealed that comorbidities bilateral pneumothorax and fever at pneumothorax/pneumomediastinum presentation were predictors for mortality. In the new scoring system, i.e., the CoBiF system, the area under the curve which was used to assess the predictability of mortality was 0.887. External validation results were also promising (area under the curve: 0.709). Conclusions: The presence of comorbidity bilateral pneumothorax and fever on presentation are significantly associated with poor prognosis in COVID-19 patients with spontaneous pneumothorax/pneumomediastinum. The CoBiF score can predict mortality in clinical settings as well as simplify the identification and appropriate management of patients at high risk.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Moon, Duk Hwan(문덕환)
Shin, Jae Il(신재일) ORCID logo https://orcid.org/0000-0003-2326-1820
Woo, Wongi(우원기) ORCID logo https://orcid.org/0000-0002-0053-4470
Lee, Sung Soo(이성수) ORCID logo https://orcid.org/0000-0001-8998-9510
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
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